전문간호사 제도와 무면허 의료행위 - 대법원 2010.3.25. 선고, 2008도590 판결 중심으로 -

김경례 대한의료법학회 2010 의료법학 Vol.11 No.1

There is a system in Korea named “Advanced Practice Nurse System” qualified by the Minister of Health, Welfare and Family Affairs for Advanced Practice Nurse besides nurse licence. Medical practice is, in today's medical law, understood as a general concept colligating medical practice, nursing practice and midwife practice and so on, for it is defined as a deed of medical technique practiced by medical personnel. Referring to the fact that the Supreme Court recognizes medical personnel as people who have medical expert knowledge, nursing practice can be recognized as a region of medical business and therefore it is not necessary to prescribe nursing practice separately from the definition of medical practice on a precedent, because nurse belongs to medical personnel. According to the precedent regarding ‘Unlicensed Medical Practice of Advanced Practice Nurse for Anesthesia’ recently sentenced by the Supreme Court, the medical practice is only allowed a doctor because it is ‘in need of special knowledge and experience because of high danger on human body' and it is judged to be an unlicensed medical practice prohibited in medical law if it is to be done by a nurse. When considering the actual situation that System for Advanced Practice Nurse for Anesthesia is established under the circumstance that an anesthetist is in want and therefore the operation has not been performed on time, and that it is being expected an anesthetist to be in need, it is necessary to legislate for the range of medical practice of Advanced Practice Nurse so that Advanced Practice Nurse System can be practically legalized, for the role of Advanced Practice Nurse has the great possibility of shrinking because the precedent has considered Advanced Practice Nurse for Anesthesia doing anesthetic operation in clinic today as a potential wrongdoer.

응급전문간호사의 전문가적 실무수행 분석

김진현,김명애,김미원,김경숙,유정숙,이은희 한국자료분석학회 2010 Journal of the Korean Data Analysis Society Vol.12 No.2

Purpose : The purpose of this study was to analyze the advanced nursing practice in emergency department used frequently by Korean ENPs and to provide basic data in order to develop nursing fee of the health insurance. Method : Practices of emergency nurses were differentiated into RN's and ENP' practices by panel of emergency nursing experts. Each Practice of ENP was defined. General hospital of Seoul where ENP is being worked, nurse practice time and frequency were checked. Result : Practice of ENP were classified 6 domain of 27 practices. Each Practice was defined and presented as step of procedure. 18 practices were completed in 10 minutes and the other 9 practices were completed from 10 to 30 minutes. Priority of performance was triage, ECG check, IV insert, blood culture and ABGA. Conclusions : ENPs carried out advanced nursing practice. Some of ENP practice were differentiated from that in RNs. It is necessity to enhance and develop other advanced practice. In order to expand of advanced nurse practitioner in system, it is necessary to evaluate economic value of advanced nursing. 본 연구는 우리나라 응급의료체계에 새로 도입된 응급전문간호사의 업무를 명확히 하기 위한 목적으로 시도되었으며, 이를 위해 응급전문간호행위를 조사하여 분류하고, 이에 대한 실제 관찰을 통해 수행 시간측정과 빈도조사를 시행하였다. 그 결과 27개의 응급전문간호행위가 분류되었으며, 이들 행위별 정의와 수행절차가 기술되었다. 응급전문 행위에 대한 관찰 결과 27개 전문간호행위의 시간 범주는 30분 이내에 있었으며, 그 중 18개의 행위는 10분 이내로 측정되었다. 수행빈도 측정결과 읍급전문간호사들이 임상에서 주로 수행하고 있는 업무로 상위 5위에 해당하는 행위는 ‘중증도분류’, ‘심전도검사’, ‘정맥로 삽입’, ‘혈액배양검사 관련 간호’, ‘동맥혈가스분석검사시 채혈과 판독’으로 나타났다.

종양전문간호사의 노인 암환자 케어 코디네이션 경험에 관한 내용분석

박미란(Mi-ran Park),염혜아(Hye-Ah Yeom) 학습자중심교과교육학회 2022 학습자중심교과교육연구 Vol.22 No.11

목적 본 연구는 케어 코디네이션을 통한 의료의 질 향상을 위해 노인 암환자에게 케어코디네이션 서비스를 제공한 종양전문간호사의 경험을 분석하였다. 방법 참여자는 노인 암환자에게 케어 코디네이션 서비스를 제공한 경험이 있는 종양전문간호사 6명으로 개별 심층 인터뷰를 하였다. 자료수집은 2017년 9월 18일부터 2018년 2월 2일까지 진행되었다. 수집된 자료는 Krippendorf의 질적 내용분석방법을 적용하여 분석하였다. 결과 분석 결과 30개의 주제, 14개의 주제 모음, 5개의 범주가 확인되었다. 5개의 범주는 ‘노인 암환자의 특성 고려’, ‘치료 전반을 함께하는 동반자로서의 전문간호사’, ‘전문간호사 역할에 대한 자부심’, ‘전문간호사의 성장을 위한 과제’, ‘노인 암환자를 위한 시스템 개선 방향’이 도출되었다. 결론 본 연구결과를 토대로 노인 암환자에게 통합적인 의료서비스를 제공하기 위해서는 전문간호사의 케어 코디네이션 서비스의 이점을 인식해야 할 것이다. 이와 함께 종양전문간호사의 역량을 높이기 위한 지속적인 지원과 다학제간 협조도 강조되어야 한다. Objectives This study aimed to analyze the experiences of oncology advanced practice nurses who provided care coordination services to elderly cancer patients. Methods This study was a descriptive study using content analysis method. Six oncology advanced practice nurses recruited from a University hospital were interviewed in-depth about their experiences of providing care coordination for elderly cancer patients. Data collection was conducted from September 18, 2017 to February 2, 2018. The data were analyzed using Krippendorf’s qualitative content analysis method. Results As a result, 30 themes, 14 themes clusters, and 5 categories were identified from the in-depth interviews. The 5 categories were ‘considering the characteristics of elderly cancer patients’, ‘advanced practice nurse as a partner for overall cancer treatment process’, ‘pride in the role of the advanced practice nurse’, ‘tasks for improvement of advanced practice nurse service’, ‘strategies for the improvement of nursing care for elderly cancer patients’. Conclusions Based on the results of this study, it is concluded that the benefits of care coordination service by advanced practice nurses should be recognized to provide more integrated healthcare services for elderly cancer patients. Consistent support and multidisciplinary collaboration should also be emphasized to increase the competency of advanced practice nurses in the field of oncology nursing.

종양전문간호사 프로그램의 실습교과 운영현황 및 방향

박정숙(Park, Jeong Sook),박정윤(Park, Jeong Yun),최자윤(Choi, Ja Yun) 대한종양간호학회 2015 Asian Oncology Nursing Vol.15 No.4

Purpose: This study was conducted to identify the present conditions of clinical practicum through analyzing guidebooks used in education institutions for oncology advanced practice nursing programs and to discuss future directions. Methods: Ten of a total of 13 education institutions participated in this study and ten guidebooks were reviewed from June 1 to October 31, 2014. The standard curriculum developed by the Korean accreditation board of nursing education was used to analyze the present conditions and an analyzing frame was developed by a research team. Two coders independently recorded the data, agreement was 92% and all disagreements was concurrent after discussion. Results: Courses in the area of ‘advanced oncology nursing’ were most highly established and, courses in the area of ‘introduction of oncology nursing’ were least established. Some learning objectives were never dealt with and some learning objectives were over dealt with. The national cancer center was most used for practicum. Diverse homework and evaluation methods were used. Conclusion: Through analyzing clinical practicum guidebooks for oncology advanced practice nursing students, we found that balanced practicum courses are needed to improve the quality of oncology advanced practice nurse programs.

Adoption of Evidence-Based Practice-Advance Directives in Nursing Homes

( Juh Hyun Shin ),( Dong Eun Jang ) 이화여자대학교 간호과학연구소 2016 Health & Nursing Vol.28 No.2

Purpose: Nursing homes commonly experience the death of residents, family members, and staff. The strategies to protect nursing home residents` autonomy at the end of life are very important. However, current end-of-life care procedures have been limited and too abstract. Many nursing home residents die without the opportunity to express their intentions. Residents` autonomy in the decision-making process in long-term care settings has been limited. This article explored the urgent problem of end-of-life care in nursing homes, as well as the advantages of and barriers to advance directives. Methods: By reviewing articles, this study has introduced and discussed Evidence-based practice-advance directives developed by the Gerontological Nursing Interventions Research Center, University of Iowa. Results: The benefits of advance directives are that the residents get the care that they want and need without losing the right and autonomy to make their own choices regarding future treatment. A major barrier to completing advance directives is that many NH residents are cognitively impaired. Conclusion: EBP-ADs have the advantage that we can expect an increased AD-completion rate with the use of EBP in nursing homes. Also, EBP-ADs can be purchased at a reasonable price, are systematically developed, and concise and easy to use.

임상전문간호사 운영 현황 및 역할 조사

권인각,김연희,황경자,김혜숙,이봉숙,이혜숙,최원자 병원간호사회 2003 임상간호연구 Vol.9 No.1

Purpose: In this study, we investigated hospitals in Korea that comprised more than 400 beds and attempted to understand the present state of Advanced Practice Nurses (APNs and below) from 11 different fields (Diabetic education, Wound-Ostomy, Neurology, Neonatal, Cardiovascular, Oncology, Emergency, Organ-transplantation, Renal, Critical care, and Hospice). We also compared and determined the time spent on the role of each nurse from each field and the frequency of implementation for each work activity. Method: This study was conducted from July 2002 to May 2003. Data from 299 nurses that responded to the survey from 57 hospitals were analyzed with descriptive statistics, chi-square test and t-test using SPSS 10.0 program. Result: Out of 299 nurses that responded, 137 nurses from 35 hospitals were officially appointed as advanced practice nurses and assumed the duties of advanced nursing practice. The remainder of the nurses were not suitable to be classified as APNs. From the fields of neurology, cardiovascular and oncology, 25~31 APNs were found respectively, amounting up 63% in total. No APNs were found in the fields of critical care and renal. Mean percentage of time spent on each role was 42.8% for direct practice, 27.7% for education, 13.2% for consultation and coordination, 8.9% for research and 6.5% for administration. Amongst the work activities of all APNs, the activities that were most frequently implemented included reading of examination results, psychosocial assessment, consultation and education for the patients and their families, managing treatment, writing up patient records, history taking, consultation for nursing staff, physical examination and triage. Although not frequently performed, nurses in some fields carried out invasive procedures and prescribed medications or tests. Conclusion: Although the number of APNs are rapidly increasing in hospitals, there is yet confusion with regards to the title and classification of APNs, as well as the distribution of roles. Thus, there is an urgent need to establish a systematic framework as well as standards. Furthermore, because some nurses are prescribing medication for patients as well as performing techniques not traditionally handled by nurses, there is an absolute need for a legalized and systematic education system for the safety of patients who are being cared for by these nurses as well as all APNs.

중환자실 전문간호사의 전문간호행위 분류와 수행분석

김진현,김명애,김미원,김경숙,유정숙,이은희 대한간호학회 간호행정학회 2009 간호행정학회지 Vol.15 No.4

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.

간호업무 관련 법령의 정합성 연구: 간호사, 조산사, 전문간호사, 간호조무사를 중심으로

김민지 ( Kim Minji ),김인숙 ( Kim Insook ),이유리 ( Lee Yuri ) 한국보건사회연구원 2018 保健社會硏究 Vol.38 No.3

간호업무와 관련하여 2015년 12월 의료법 일부개정이 이루어졌고, 2018년 3월 전문간호사 자격 기준 근거가 시행규칙에서 의료법의 법률 차원으로 상향되었다. 이렇듯 법령의 개정을 통하여 간호업무 규정을 수정 및 보완하고 있으나, 여전히 간호업무와 관련해 일선 간호현장에서 문제점이 나타나고 있다. 본 연구에서는 간호사, 조산사, 전문간호사, 간호조무사를 중심으로 간호업무 근거 법령들을 살펴보고, 여러 법령 간에 정합성을 이루고 있는지 고찰하였다. 간호업무 관련 규정사항이 존재하는 법률은 총 14개이다. 법의 완전성을 분석한 결과, 전문간호사 업무 등에 관한 규정이 없는 흠결을 보였다. 일관성 관점에서는 의료법과 타 보건의료법령에 명시된 간호업무 간 일부 충돌이 나타났다. 수평적 정합성 분석결과, 산발적인 법령 규정으로 인해 해석이 일의적이지 않아 실제 간호업무 수행에 있어 혼란 가능성을 확인하였다. 수직적 정합성 분석결과, 간호업무 관련 일부 조문에서 일정 사항을 위임하였으나 하위 법령에 해당 규정이 없는 입법미비가 나타났다. 본 연구에서는 비정합적 요소들의 확인을 통해 간호업무 관련법령 정합성 제고 방안으로 현행 법체계를 유지하면서 정합성 결여 요소들을 제·개정 및 삭제하여 보완해나가는 방안과 산재하여 있는 간호 관련 법령들을 통합하여 간호법으로 제정하는 방안을 제시하였다. 추후 보건의료관련법령 개정 혹은 간호법 제정 시법체계의 정합성 확보를 위해 본 연구 결과를 활용할 수 있을 것으로 기대한다. Related to nursing services, the Medical Services Act was amended in December 2015 and the grounds of advanced practice nurse’s qualification was ruled in the law in March 2018. Although legislations related to nursing services have been modified constantly, there remain problems of nursing staffs those are not covered enough by current legislations. The purpose of this study was to review nursing services laws and regulations, especially for nurse, midwife, advanced practice nurse and nurse assistant and to examine legal coherence among them. There are 14 acts that have provisions related to nursing services. In terms of completeness there is no regulation about nursing services of advanced practice nurse. With respect to consistency there is contradiction among legislations provisions in the Medical Service Act and those in other health laws regulating nursing services. Based on analysis of horizontal coherence, confusion may occur because legislations exist sporadically which causes different interpretation. Vertical coherence analysis shows absence of some lower statutes in spite of the delegation. This study suggests two ways to enhance coherence. One is to maintain current legislations while amending the provision preventing them coherent. The other is to enact the unified Nurse Act. This study is meaningful as there is only few preceding research on legal coherence in health system.

간호사의 법적 책임에 관한 연구

범경철 대한의료법학회 2014 의료법학 Vol.15 No.2

의료분쟁이 증가함에 따라, 간호사와 관련된 의료분쟁의 건수도 상대적으로 증가하고 있어 연구가 필요한 분야로 대두되고 있다. 하지만 여전히 간호사와 환자간의 법률관계에 대해서는 연구가 미진한 것이 사실이다. 하지만 최근 간호학의 발달로 간호사들의 역할과 기능이 다양하게 확대됨에 따라 간호사들의 활동과 책임한계도 넓어졌다. 이에 따라 간호사들의 의료분쟁 발생빈도도 증가하고 있다. 하지만 아직도 간호사의 업무는 의사의 역할에 대한 보조적인 행위를 하는 것으로 인식될 뿐이어서 의사의 총괄책임에 포함되어 넘어가는 경우가 대부분이다. 또한 간호사의 업무는 의료행위 중 일부를 구성하는 것이지, 의사의 역할에 보조적인 행위를 하는 것이 아니다. 물론 업무의 성격은 의사의 행위에 대한 보조적인 업무도 많으나, 이것은 어디까지나 간호사의 업무 중 일부에 지나지 않는다고 보아야 한다. 또한 간호사도 의료인이므로 의료행위에 관한 일반사항은 의사와 다를 것이 없다. 이러한 간호사의 특성 및 현재 우리의 의료상황에 비추어 보건대 간호사의 업무가 고도화・전문화 되어 가고 있는 것이 사실이며, 간호사의 독자적인 영역도 확고히 굳혀가고 있다 할 것이다. 이러한 시대 흐름 속에서 환자 안전과 국민 건강증진을 위한 간호사에 관한 독립법률 즉 간호법 제정을 위한 목소리도 커지고 있다. 이에 비추어보건대 간호사의 책임도 그 만큼 커질 것이 명확하다. 즉 간호사가 의사의 지시에 따라 간호를 수행하고 그 결과의 책임 또한 의사에게 돌리던 시대는 지나간 것이다. 따라서 본 논문에서는 간호행위의 성질 및 법적 책임에 대해 설명하고, 향후 간호사와 환자간의 법적분쟁 발생 시 효과적으로 대처하기 위한 제도적 장치에 대해 논의해보고자 한다. 이를 통해 향후 간호사와 환자간의 분쟁 발생 시 판단에 있어 단초를 제공하는 것이 이 논문의 목적이라 할 것이다. As the number of medical disputes regarding nurses has increased after medical disputes have increase, there is a need for a study on it. However, the legal relationship between nurses and patients has not yet been analyzed. Recently, the role and function of nurses are expanded according to the development of the science of nursing; moreover their activity and limitation of responsibility are also expanded. For this reason, the medical disputes regarding nurses have been increasing. However, the majority of these kind of dispute are just passed over because their practice is usually considered to be a mere action to assist doctor’s role. In addition, nurse practice is not a secondary action of doctor’s role, but forms part of a medical treatment. Of course, nurses handle many secondary tasks after doctors finish their medical treatment. But this is only part of the whole tasks of nurses. Furthermore, the general details of their medical treatment are not different from those of doctors because they also belong to the medical service personnel. Considering these features of nurse and the medical condition in South Korea, their task is becoming increasingly developed and specialized and they are also establishing their own field. With this stream of times, there is a growing interest in enacting a Nursing Practice Act, in other words, the independent law on nurse for the sake of patient safety and national health promotion. Then, their responsibility will distinctly be expanded as much more. That is, the time that nurses practice their medical care by following doctors’ order and also pass over their responsibility to doctors is closed. Thus, this study examines the features and responsibilities of nursing practice, and discusses an institutional framework to efficiently cope with the legal disputes between nurses and patients. It aims to throw light on the decision making on nurse-patient disputes in future.

종양정문간호사가 제공한 간호서비스의 구조·과정적 측면의 분석

김민영 대한간호학회 간호행정학회 2008 간호행정학회지 Vol.14 No.3

Purpose: The purpose of this study was to investigate nursing services of Oncology Advanced Practice Nurses(OAPNs) from the view point of structure and process. Methods: Roles and practices of OAPNs for cancer patients on chemotherapy were investigated by semi-structured interview and survey. Subjects were 14 OAPNs in 3 hospitals. Results: OAPNs had high level of education and certification than registered nurses. Most subjects of OAPNs were patients on chemotherapy and OAPNs used most of their time in education and expert nursing practice. 57.1% of OAPNs used delegated order. They were satisfied with their job in general, but satisfaction in communication with nurse manager or resident doctor was low. Conclusion: These results will be the concrete explanation for the nursing services of OAPNs. On the basis of theses results, more study about effects of OAPNs will be needed.